Acta Oto-Laryngologica最新文献

Background: Endoscopic sphenopalatine artery cauterization (ESPAC) has become an important method to manage posterior epistaxis.

Aims/objectives: To investigate the application of plasma knife and lateral nasal wall incision in ESPAC in the treatment of posterior epistaxis.

Material and methods: A retrospective study of 32 cases who underwent ESPAC for epistaxis was conducted. A vertical incision was made on the lateral nasal well to expose the sphenopalatine artery (SPA). The main branches of SPA were cauterized with a plasma knife or bipolar coagulation forceps. Cases were divided into plasma knife group (group PK) and bipolar group (group BP). The re-bleeding rates, operation time and the incidence of serious complication were compared between the two groups.

Results: ESPAC was successfully completed via a lateral nasal wall incision without maxillary antrostomy in all cases. All the patients were followed-up for 3 months, no serious complication was reported. There was no significant difference in re-bleeding rates and incidence of serious complication between the two groups. The operation time of group PK was shorter than group BP.

Conclusions and significance: Lateral nasal well incision without maxillary antrostomy is feasible for ESPAC. The application of a plasma knife may help to shorten the operation time.

Background: The delivery of drugs into the inner ear is a challenging field of study due to the complex cochlear anatomy and physiology. The creation of an intracochlear device that allows for short- and long-term intracochlear delivery of the drugs with a minimal invasive technology is needed to prevent or treat conditions that can potentially prevent the development of permanent hearing loss.

Aim: This study intends to test the efficacy of DXM-infused PLGA microneedles created in our laboratory in an in vivo animal model of acute ototoxic injury.

Material and methods: Twenty-four male Norway Brown rats were randomized into four groups, three of which groups received an intratympanic injection of ethacrynic acid and kanamycin. Two of these groups underwent the placement of an intracochlear microneedle blended or not with dexamethasone, and two groups underwent implantation of a plain microneedle, one of without prior exposure to the ototoxic agent to confirm in vivo biocompatibility. Animals were then followed with a weekly auditory brainstem response testing until day 28 after surgical intervention.

Result and conclusion: Our intracochlear device demonstrated biocompatibility and produced no hearing changes after its implantation in the control group. Inserted DXM-blended microneedles prevented hearing deterioration in those animals exposed to an ototoxic environment.

Background: In oral cancers, tumour borders are typically defined by white light (WL). Narrow-band imaging (NBI) is an optical endoscopic technique commonly used for the larynx and for cancers of unknown primary. However, evidence for using NBI in oral cancers is insufficient.

Aims/objectives: We investigated whether NBI is a better predictor of the true mucosal tumour borders than WL in oral cancers. Additionally, we examined the agreement between NBI-based Takano intrapapillary capillary loop classifications and pathology reports.

Materials and methods: In this prospective study, the tumour borders were assessed by both NBI and WL at the time of surgical resection and then compared. Pathology reports of the examined areas were used as gold standard.

Results: Forty-nine participants were included. After exclusion of 15 patients due to missing data, 34 were included in analyses. In 26.5% of the assessments, the tumour borders defined by NBI were outside the borders defined by WL. However, 55.5% of these were false-positives.

Conclusions and significance: The delineation of mucosal tumour borders in oral cancers by NBI was not better than that by WL in this study. Several methodological challenges may have influenced the findings of this study, similar to the limitations reported in previous studies.

Background: Tonsillectomy is an effective treatment option for obstructive sleep apnoea in selected adult patients, but there has been a lack of long-term follow-up data.

Objectives: To analyse the long-term outcomes of extracapsular tonsillectomy in the treatment of obstructive sleep apnoea in adults, with the longest follow-up periods to date.

Materials and methods: We recruited adults who had undergone extracapsular tonsillectomy because of obstructive sleep apnoea between 2004 and 2018 in the Hospital District of Southwest Finland. A new home sleep study, questionnaires, and a structured phone interview were conducted on these patients 4-17 years after surgical treatment. The primary outcome was the change in the apnoea-hypopnoea index.

Results: The mean apnoea-hypopnoea index was reduced from 27.1 preoperatively to 14.1 after the long-term follow-up (mean 12 years), and the mean Epworth Sleepiness Scale score decreased from 9.2 to 4.6. The long-term surgical success rate was 38.5%. Four out of five patients would choose the surgery again according to the phone interview.

Conclusions and significance: This study supports the notion that extracapsular tonsillectomy alone can be considered as a surgical treatment option for selected adults with obstructive sleep apnoea and tonsillar hypertrophy. For most of the patients, the obstructive sleep apnoea is alleviated.

Background: Hematopoietic stem cell transplantation (HSCT) is a critical treatment for various hematologic malignancies but can lead to complications, including ototoxicity.

Aim/objectives: This study aims to explore the relationship between patient-specific factors and ototoxicity in adult HSCT patients.

Material and methods: We conducted a retrospective analysis of 129 adult patients who underwent HSCT between 2003 and 2020. Age, gender, transplant indications, conditioning regimens, and pre- and post-transplant audiometry thresholds data were collected from patient files. A hearing loss of 10 decibels or more at two consecutive frequencies or a hearing loss of 20 decibels or more at a single frequency was considered as significant hearing loss (SHL). Statistical analyses were performed to describe factors associated with SHL.

Results: SHL occurred in 16.3% of patients. Older age was significantly associated with an increased risk of SHL (p = .035). Poorer pretransplant hearing thresholds at 4000 Hz and 6000 Hz were also significant predictors of SHL (p = .039 and p = .014, respectively). There was no significant relationship between the donor type of HSCT (autologous vs. allogeneic) and ototoxicity (p = .45), and between conditioning regimens and ototoxicity (p = .860).

Conclusions: Age and pre-existing hearing levels are significant predictors of ototoxicity post-HSCT. Careful management and monitoring are essential to prevent and address hearing loss in HSCT patients to improve hearing-related quality of life.

Background: The presence of Actinomyces can be associated with complications.

Aims: This study aimed to determine the frequency of post-tonsillectomy hemorrhage (PTH), the presence of Actinomyces in palatine tonsils and serum inflammatory biomarker levels in PTH.

Material and methods: The cases who underwent tonsillectomy at a single center were included in the study. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII) and systemic inflammation response index (SIRI) values were calculated from the complete blood count test. The presence of Actinomyces was recorded from histopathological tonsillectomy material.

Results: A total of 1137 patients were included in the study. Actinomyces was detected in 93 (8.18%) patients. Bleeding complications were encountered in 65 cases (5.72%). No relationship was detected between the presence of Actinomyces and PTH rates (p = 0.433). While a relationship was found between age, NLR, and SIRI values and Actinomyces status (respectively, p < 0.001, p = 0.017, p = 0.038), no statistically significant relationship was found between tonsil size, PLR, and SII (p > 0.05).

Conclusion and significance: According to the data in our study, NLR and SIRI values were elevated in subjects with Actinomyces. Our findings suggest that this entity has a systemic manifestation. Serum inflammatory biomarkers and the presence of Actinomyces were not found to be associated with PTH.

Background: Deep neck infections (DNIs) in the cervical fascial planes can cause severe complications such as airway obstruction, mediastinitis, and sepsis.

Aims/objectives: This study examines cervical abscess development, its relationship with postoperative swallowing function, and hospital stay duration.

Material and methods: A retrospective case series of 55 DNI patients was divided by hospital stay (<30 days: Group A, ≥30 days: Group B) and swallowing recovery (<6 days: Group C, ≥6 days: Group D). Swallowing was assessed using FOIS; abscesses were categorized via CT and surgery.

Results: Longer hospital stays (Group B) were associated with tracheostomy (p = .027) and thoracoscopic mediastinal drainage (p = .038), shorter time between symptom onset and surgery (p = .016), and abscesses in the anterior cervical (p = .007), retropharyngeal space (p = .026), and mediastinal spaces (p = .002). Dysphagia (Group D) was linked to longer hospital stays (p = .006), more abscesses in the anterior cervical (p = .049) and retropharyngeal spaces (p = .009), and higher cases of intubated feeding (p < .001). Streptococcus constellatus was more prevalent in Group D (p = .04), whereas Staphylococcus aureus was less common (p = .043).

Conclusions and significance: Dysphagia is associated with abscesses in the anterior cervical and retropharyngeal spaces and higher Streptococcus constellatus prevalence, indicating delayed oral intake recovery. Thoracoscopic mediastinal drainage and shorter time to surgery were linked to prolonged hospital stays.

Background: Inverted papilloma is a benign epithelial tumour located in the sinonasal tract with a high recurrence rate and a potential of malignant transformation. From 2017, patients with IP were included in our fast-track regime similar to head and neck cancer patients, including follow-up at 2, 6, 12, 18 and 24 months after surgery, then yearly for a total of 5 years.

Aims/objectives: This study aims to compare the recurrence rate and malignant transformation of patients with IP treated at a university centre following the implementation of a fast-track regime including a close follow-up.

Methods: A retrospective study was performed on all patients with IP diagnosed between 2018 and 2022.

Results: The study included 125 patients, all surgically treated for IP. Eight patients (6%) also presented with SCC at the time of diagnosis. The recurrence rate of benign IP was 17%. Most tumours originated in the maxillary sinus (48/117, 41%). No cases of metachronous cancer were seen during the follow-up.

Conclusions and significance: The majority of recurrences (90%) occurred within the first 2 years after treatment. No cases of malignant transformation were seen in the follow-up period. The rigorous follow-up program potentially contributed to the detection of recurrence before malignant transformation.

Backgrounds: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a medical condition characterized by persistent inflammation of the nasal mucosa and sinuses, accompanied by the presence of nasal polyps. When medical treatments prove ineffective, endoscopic sinus surgery (ESS) is recommended, yielding variable outcomes and recurrence rates ranging from 5% to 60%.

Aims/objectives: The primary objectives of this study were to evaluate the outcomes of ESS and to identify independent predictors of recurrence and revision surgery.

Material and methods: Retrospective cross-sectional study, focusing on patients diagnosed with CRSwNP who underwent ESS with a minimum follow-up period of 60 months. Various variables were collected. Multivariate and regression analyses were employed to assess the predictors associated with both recurrence and revision surgery.

Results: The study analyzed 130 patients. The 5-year recurrence rate was 35.4%, and 17.7% of patients required revision surgery. These variables included asthma (p < 0.001), frontal sinus involvement (p < 0.001), Lund-Mackay score (p < 0.001), Endoscopic Nasal Polyps Score (p < 0.001), and eosinophilia in peripheral blood (p < 0.001). All the variables mentioned above were identified as predictors of recurrence and revision surgery.

Conclusions and significance: Asthma, frontal sinus involvement, increased eosinophilia in peripheral blood, and a higher score on the LM system and NPS are poor prognostic factors in CRSwNP.

Background: endoscopic ear surgery in patients Chronic Otitis Media(COM) media with eardrum atelectasis.

Objective: to compare the postoperative outcomes and audiological results of the endoscopic approach versus the microscopic approach for treatment of COM media with eardrum atelectasis, using a randomized prospective model.

Methods: Sixty patients were consecutively enrolled in the study and randomized into two groups: Group A 32 patients underwent canal wall up tympanoplasty (CWA); Group B 28 patients underwent tympanoplasty with an exclusive trans-meatal endoscopic approach. Audiological results and preoperative, intraoperative and postoperative outcomes were evaluated.

Results: No statistical difference emerged between distribution of middle ear atelectasis patients grade 3 and 4 between the two surgical groups (p > 0.05). The group B appeared to have shorter surgical times than group A (69.8 min vs. 88.9 min). The graft success rate was estimated in 90.6% and 92.8% in group A and B respectively, without statistical differences between groups (p = 1). The Overall success rate was therefore calculated in 87.5% and 92.8% for both groups.

Conclusion and significance: Endoscopic ear surgery could be a suitable approach for treating COM media with eardrum atelectasis with similar results compared with the Microscopic surgery.